Survivors of intracerebral hemorrhage (ICH) face an elevated risk of ICH recurrence, worsening functional disability, and death. Now, new research indicates that poor control of blood pressure after ICH may contribute to a higher risk of both lobar and nonlobar ICH recurrence. The data was published in the Journal of the American Medical Association (JAMA).
Alessandro Biffi, MD, of Massachusetts General Hospital in Boston, and colleagues conducted an observational single-center cohort study of ICH survivors in order to investigate the effects of blood pressure control on ICH recurrence. A total of 1,145 ICH patients survived at least 90 days and were followed up with for a median of 36.8 months and minimum of 9.8 months. Blood pressure was measured and recorded at various intervals (3,6, 9, 12 months, every 6 months thereafter), patients were classified as having adequate or inadequate blood pressure control based on AHA/ASA recommendations, and stage of hypertension was determined.
Among 505 survivors of lobar ICH, 102 recurrent ICH events were recorded, while 44 cases of recurrent ICH occurred among the 640 survivors of nonlobar ICH. Adequate blood pressure control was achieved on at least one measurement by 625 patients and consistently by 495 patients. The rate of lobar ICH among patients with inadequate blood pressure control was 84 per 1,000 person-years compared to 49 per 1,000 person-years for those with adequate control. Nonlobar ICH among patients with inadequate blood pressure control was 52 per 1,000 person-years compared to 27 per 1,000 person-years for those with adequate control.
Inadequate blood pressure control was associated with higher risk of recurrence of both lobar ICH (hazard ratio [HR], 3.53 [95% CI, 1.65-7.54]) and nonlobar ICH (HR, 4.23 [95% CI, 1.02-17.52]). Systolic blood pressure during follow-up was associated with increased risk of recurrence of both lobar ICH (HR, 1.33 per 10-mm Hg increase [95% CI, 1.02-1.76]) and nonlobar ICH (HR, 1.54 [95% CI, 1.03-2.30]). Diastolic blood pressure was associated with increased risk of nonlobar ICH recurrence (HR, 1.21 per 10-mm Hg increase [95% CI, 1.01-1.47]) but not with lobar ICH recurrence (HR, 1.36 [95% CI, 0.90-2.10]).
The authors suggested that randomized clinical trials be conducted in order the effects of stricter blood pressure control for ICH survivors.